Roseola Infantum

Aka: Roseola Infantum, Roseola, Sixth Viral Exanthem of Childhood, Exanthem Subitum, Human Herpes Virus 6, HH6

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II. Causes

  1. Human Herpes Virus (Herpesviridae)
  2. Human Herpes Virus (HHV) Type 6 (most common)
  3. Other viruses may, less commonly, cause a similar presentation
    1. HHV 7
    2. Enterovirus
    3. Coxsackievirus
    4. Adenovirus
    5. Parainfluenza Virus

III. Epidemiology

  1. Peak ages: 6-18 months
  2. Peak seasonal distribution in late summer and early fall
  3. Transmission is typically from asymptomatic shedding from older siblings and adults
  4. Very common
    1. Prevalence of Antibody to HHV-6 approaches 100% by 3 years of age

IV. Signs

  1. Days 1-2
    1. Anorexia
    2. Vomiting
    3. Diarrhea (variable)
    4. Mild cough or Rhinorrhea (variable)
    5. Occipital Lymphadenopathy
  2. Days 2-3
    1. High Fever starts (103 to 106 F)
      1. Occurs at onset without accompanying localizing signs
      2. Fever Without Focus
        1. Often a diagnostic dilemma until the rash appears
        2. Child appears well without focal findings
        3. Mild cough or Rhinorrhea may be present
        4. Mild Diarrhea may be present
  3. Day 4
    1. Rash onset as fever abates
      1. Fine, erythematous or pink Macules and Papules (maculopapular rash)
      2. Pink, blanchable, almond shaped Macules
      3. Most common centrally on the trunk and neck (may spread peripherally to extremities)
      4. Macules become confluent with one another and then fade within hours to 2 days
    2. Other associated findings
      1. Viral Sialoadenitis (especially Parotid Gland)

V. Differential Diagnosis

  1. See Fever Without Focus
  2. Rubeola (Measles)
    1. Rash in Measles starts on face (especially behind ears) and spreads inferiorly
    2. Children with Measles appear ill (contrast with normal appearance in Roseola)

VI. Complications

  1. Febrile Seizures (common cause)

VII. Management

  1. Symptomatic
  2. Tylenol or Ibuprofen for fever

VIII. References

  1. Latessa (2012) AAFP Board Review Express, San Jose
  2. Allmon (2015) Am Fam Physician 92(3): 211-6 [PubMed]
  3. Longfellow (2023) Am Fam Physician 107(6): 649-50 [PubMed]

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